title: Clinical prediction and diagnosis of neurosyphilis in HIV-infected patients with early Syphilis.
abstract: The diagnosis of neurosyphilis (NS) is a challenge, especially in HIV-infected patients, and the criteria for deciding when to perform a lumbar puncture (LP) in HIV-infected patients with syphilis are controversial. We retrospectively reviewed demographic, clinical, and laboratory data from 122 cases of HIV-infected patients with documented early syphilis who underwent an LP to rule out NS, and we evaluated 3 laboratory-developed validated real-time PCR assays, the Treponema pallidum particle agglutination (TPPA) assay, the fluorescent treponemal antibody absorption (FTA-ABS) assay, and the line immunoassay INNO-LIA Syphilis, for the diagnosis of NS from cerebrospinal fluid (CSF) samples of these patients. NS was defined by a reactive CSF-VDRL test result and/or a CSF white blood cell (WBC) count of >20 cells/μl. Thirty of the 122 patients (24.6%) had early NS. Headache, visual symptoms, a CD4 cell count of <500 cells/μl, and viremia, as defined by an HIV-1 RNA count of ≥50 copies/ml, were associated with NS in multivariate analysis (P = <0.001 for each factor). Blood serum rapid plasma reagin (RPR) titers were not associated with early NS (P = 0.575). For the diagnosis of NS, the PCR, FTA-ABS, TPPA, and INNO-LIA assays had sensitivities of 58%, 100%, 68%, and 100%, specificities of 67%, 12%, 49%, and 13%, and negative predictive values of 85%, 100%, 84%, and 100%, respectively. Visual disturbances, headache, uncontrolled HIV-1 viremia, and a CD4 cell count of <500 cells/μl were predictors of NS in HIV-infected patients with early syphilis, while blood serum RPR titers were not; therefore, RPR titers should not be used as the sole criterion for deciding whether to perform an LP in early syphilis. When applied to CSF samples, the INNO-LIA Syphilis assay easily helped rule out NS.
authors.affiliation: Département de Microbiologie et d'Infectiologie, Centre Hospitalier Affilié Universitaire Hôtel-Dieu de Lévis, Lévis, Québec, Canada.
authors.forename: Jeannot
authors.initials: J
authors.lastname: Dumaresq
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Langevin
authors.forename: Simon
authors.initials: S
authors.lastname: Gagnon
authors.forename: Bouchra
authors.initials: B
authors.lastname: Serhir
authors.forename: Benoît
authors.initials: B
authors.lastname: Deligne
authors.forename: Cécile
authors.initials: C
authors.lastname: Tremblay
authors.forename: Raymond S W
authors.initials: RS
authors.lastname: Tsang
authors.forename: Claude
authors.initials: C
authors.lastname: Fortin
authors.forename: François
authors.initials: F
authors.lastname: Coutlée
authors.forename: Michel
authors.initials: M
authors.lastname: Roger
mesh_terms: D000328:Adult; D000368:Aged; D000907:Antibodies, Bacterial / Q000032:analysis*; D002555:Cerebrospinal Fluid / Q000382:microbiology*; D019411:Clinical Laboratory Techniques / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000150:complications*; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D009494:Neurosyphilis / Q000175:diagnosis* / Q000473:pathology*; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014210:Treponema pallidum / Q000276:immunology / Q000302:isolation & purification*; D055815:Young Adult
chemical_list: D000907:Antibodies, Bacterial